obstetrics Flashcards
(278 cards)
1
Q
how may placenta praevia present
A
painless PV bleeding
maternal condition correlates with blood loss
malpresentation of foetus - transverse/ oblique (placenta occupies lower uterine segment)
soft, non tender uterus
2
Q
when do ectopic pregnancies typically present
A
8 weeks
3
Q
what things is placental abruption associated with
A
pre eclampsia chronic hypertension maternal age/ multiparty smoking/ cocaine abdominal trauma polyhydramnios
4
Q
what is the difference between parity and gravidity
A
parity - pregnancies that resulted in delivery beyond 28 weeks gestation
gravidity - pregnancies that a women has had to any stage
5
Q
what is a complete miscarriage
A
complete expulsion of the products of conception (POC) cervix closed and bleeding has stopped
should ideally have confirmed the POC or should have had a scan previously that confirmed an intrauterine pregnancy
6
Q
what may be necessary if the placenta does not separate (placenta accrete)
A
hysterectomy
7
Q
what is a 2nd degree perineal tear
A
lacerations involve the perineal muscle (repair similar to episiotomy)
8
Q
what is the difference in the pain and uterus between placental abruption and placenta praevia
A
pa - very painful, tender/ tense uterus
pp - painless, non tender uterus
9
Q
what are early symptoms of pregnancy
A
amenorrhoea nausea/ vomitting bladder irritability temperature rise (headaches) palpitations abdominal pain / backache ankle oedema leg cramp
10
Q
what are some population/ community based methods of measuring maternal deaths
A
notification by law
vital registration
census
survey/ surveillance - ask sister
11
Q
why is a prolapsed cord an emergency
A
cord compression can cause foetal asphyxia
12
Q
how is nuchal translucency measured
A
crown - rump length (45mm-84 mm)
closely correlates with gestational age - allows estimated date to be decided
13
Q
what is the pathogenesis of DIC in pregnancy
A
thromboplastin are released into the circulation, fibrin and platelets are consumed as intravascular clotting occurs
14
Q
why may a previous casearean section increase your chance of placenta praevia
A
placenta implants in scar tissue
15
Q
which parity does pre-eclampsia most commonly happen in
A
1st (condition of null parity)
16
Q
how long may the first stage of labour take in primiparous or multiparous woman
A
primiparous - 8-18 hours
multiparous - 5-12 hours
17
Q
what skin changes are seen in pregnancy
A
linea nigra
nipple enlargement/ darken / montgomerys tubercles
palmar erythema
spider nave
striae
chloasma - patch of darker pigmentation
Pruritic eruption of pregnancy (PEP) - intensely itchy papular/ plaque rash on abdomen and limbs
18
Q
when is an elective caesarean section indicated
A
known cephalon-pelvic disproportion
placenta praevia
breech presentation
after vaginal surgery
19
Q
what are the main effects of progesterone during pregnancy
A
decrease smooth muscle excitability - uterus, gut (constipation, heartburn)
raises body temperature
(synthesised corpus luteum 35 days post conception then by placenta)
20
Q
what does gestational diabetes increase your risk of later in life
A
type II diabetes
21
Q
what are benefits of skin to skin contact of mum and baby
A
stimulate prolactin and oxytocin
calms both
regulated baby HR and breathing
regulates body temp
22
Q
why is an episiotomy performed
A
enlarge the outlet
- hasten birth of distressed baby, instrumental/ breech delivery, protect premature head, prevent 3 degree tears
23
Q
how is VTE prevented in pregnancy
A
TED stockings
increased motility and hydration
prophylactic anti-coagulation - dalteparin
24
Q
what are antepartum causes of stillbirth
A
malformation congenital infection (TORCH) pre-eclampsia antepartum haemorrhage post term
25
when may a 3rd trimester ultrasound be carried out
if baby feels large or small for dates
| standard measurements of head, abdomen and femur on growth chart
26
what condition are renal patients likely to develop in pregnancy
pre-eclampsia - may be difficult to diagnose of already have proteinuria and pre-existing hypertension
27
what is the management of major placental praevia (placenta covers internal os)
caesarean section
28
what does obesity increase the rate of in pregnancy
miscarriage
still birth
venous thromboembolism
more difficult to measure fundal height/ monitor growth
29
what things increase the nuchal translucency measurement
increasing gestational age
| incidence of chromosomal and other abnormalities
30
what is the surgical management of an ectopic pregnancy
other tube healthy - salpingectomy
| other tube not healthy - salpingotomy
31
what is a septic miscarriage
an infection form an incomplete abortion spreads from the uterus throughout the pelvis
32
what shoulder is born first
anterior
| head then rotates externally back to its initial direction (restates)
33
what are the 4T's that cause a PPH
Thrombin
Tone
Trauma
Tissue
34
what its he best way to correct a mother with iron deficiency anaemia
oral iron tablets
35
how may an acute maternal infection lead to a loss of pregnancy
general toxic illness with high temperature that can stimulate uterine activity
36
what is the overall risk of down syndrome
1 in 700
| maternal age biggest risk factor
37
what are the 3 possible chorion/ amniotic sac positions for twins to form
dichorionic, diamniotic - dizygotic
monochorionic, diamniotic - monozygotic
monochorionic, monoamniotic (rarest)
38
what 3 hypertensives are used to control chronic hypertension in pregnant women
labetalol, nifedipine, methyldopa
| aim to keep <150/100
39
what is the disadvantage of a salpingotomy compared to a salpingectomy
increased chance of another ectopic pregnancy
40
where is alpha fetoprotein secreted from
yolk sac
foetal GI tract and liver
levels peak in the foetus at the end of the 2nd trimester _ 30 weeks gestation in mum
41
what is a stillbirth
babies born dead after 24 weeks completed gestation
| can occur at any stage of pregnancy or labour
42
what examination should be avoided in placenta praevia
PV - can trigger a bleed
| advise against intercourse
43
what blood products are increased and decreased in pregnancy that make it a hypercoaguble state
increased - fibrinogen, factor VIII, VW factor, platelets, fibrinolysis
decreased - natural anticoagulants - antithrombin III
44
where do most ectopic pregnancies occur
fallopian tube (97%) - mostly ampulla
45
why may an ectopic present with nausea/ diarrhoea or shoulder pain
pressing on structures
| diaphragmatic irritation produces shoulder tip pain
46
are people with gestational diabetes or type I/II diabetes more at risk of foetal complications?
type I/II
47
what things may block the lower genital tract and cause an antepartum haemorrhage
```
cervical polyps
carcinoma
cervicitis
vaginitis
fibroids
```
48
what is gestational hypertension defined as
pregnancy induced hypertension with no proteinuria that develops after 20 weeks
49
how may septicaemia in obstetric shock present
fever, vomitting, diarrhoea, abdominal pain
rash - streptococcal maculopapular
hypotension, tachycardia
50
how does fetal hyperinuslinaemia occur
maternal glucose crosses the placenta and induces increased insulin production in the foetus
51
what are the 3 classifications of placental abruption
Revealed - haemorrhage released form cervical os
concealed - haemorrhage between the placenta and uterine wall - uterine contents increase in volume and increase fundal height
mixed - both
52
how is eclampsia prevented for people with pre-eclmapsia
take aspirin from 12th week if high risk
| magnesium sulphate halves risk of eclampsia
53
what factors increase the incidence of stillbirth
multiple pregnancy, maternal age, smoking, obesity
54
what is a retained placenta associated with
```
pre-term delivery
maternal age >35
low placental weight
parity >5
induced labour
pethidine used in labour
```
55
how is the placental manually removed
lithotomy position, insert hand into cervix and separate, remove by cord traction
56
what are general risks for a prolapsed cord
```
multiparity
low birth weight
pre term labour
breech presentation - transverse/ oblique
second twin
low lying placenta
```
57
why is there a phsyiological anaemia in pregnancy
rise in plasma volume bigger than increase in RBC so drop in haemoglobin by dilution
58
what are the ways to measure urine for proteinuria in PET
urinalysis
spot urine protein: creatine ration >30mg/mmol (confirm)
24 hour urine collection > 300mg/day
59
what is the incidence of twins /200
3
60
when is anti D IgG given to pregnant women
prophylactically
| and after any sensitising event
61
why do insulin requirements of the mother increase during pregnancy
```
human placental lactose
progesterone
human chorionic gonadotrophin
cortisol from the placenta
- all have anti insulin affects
```
62
what is the process of chronic villus sampling
sample taken from chorions of baby
| attached to uterus so may be contaminated by maternal DNA
63
what are intrapartum causes of stillbirth
placental abruption
maternal and foetal infection
cord prolapse
uterine rupture
64
what is an inevitable miscarriage
the cervix begins to dilate and the abortion is inevitable
| bleeding may be heavy and may clot
65
what are causes of antepartum haemorrhage
```
placenta praevia
placental abruption
vasa previa - rare
uterine causes
lower genital tract blocking
```
66
what is the management of shoudler dystocia
```
H - call for help
E - evaluate for episiotomy
L - legs (mc roberts postions)
P - suprapubic pressure
E - enter manouvres (internal rotation)
R - Remove posterior arm
R- roll onto all 4s
```
67
what street drugs are addictive to the foetus
methadone
heroin
benzodiazepines
(causes withdrawal syndrome)
68
what is the difference between a salpingectomy and salpingotomy
salpingotomy - removal of affected part of tube
| salpingectomy - removal of full tube
69
what are the TORCH congenital infections
```
toxoplasmosis
other
rubella
CMV
herpes
```
70
how is DIC in pregnancy managed
o2
| fresh frozen plasma
71
what is thought to be the cause of pre-eclampsia
impaired trophoblasts invade the maternal spinal arterioles leading to reduced placental perfusion - increased BP to compensate
imbalance of vasoconstrictors > vasodilators in pregnancy - increase BP
72
what position is used to deliver a baby with shoulder dystocia
McRoberts - hyper flexed lithotomy
73
what may be complications in neonates of maternal diabetes
impaired lung maturity
neonatal hypoglycaemia
jaundice
74
when should be thromboprophylaxis be given for caesarean section
if elective and 1 or more risk factors
| if emergency
75
what is the best way for pregnant diabetics to tightly control their glucose
insulin
76
what is gestational diabetes
carbohydrate intolerance with onset (or first recognised) in pregnancy and abnormal glucose tolerance test that reverts to normal after delivery
77
what things are placenta praevia associated with
```
previous caesarean
multiple pregnancy (increased mass)
mother >40
assisted conception
fibroids
endometritis
```
78
what are predisposing factors for having twins
family history of dizygotic
increased maternal age
induced ovulation/ IVF
79
how long should you listen for the foetal heart rate after a contraction (doppler or pinard)
1 min after contraction
| every 15 min
80
how would you investigate a suspected DVT in pregnancy
Doppler of lower limbs
81
what are risk factors for developing pre-eclampsia
high - chronic hypertension, previous gestational hypertension, chronic kidney disease, diabetes, autoimmune disease
moderate - primarparous, >40 years, pregnancy interval >10 years, BMI >35, family history, multiple pregnancy
82
if a rhesus -ve woman is carrying a rhesus +ve child, what antibodies would she develop if the fetal blood cells entered her circulation (miscarriage, ectopic, APH, birth)
anti- D antibodies
83
how many placental abruption present
severe abdominal pain
vaginal bleeding
increased uterine activity - tender and irritable
84
what is the point of the 1st trimester screening
ensure pregnancy viable
identify abnormalities incompatible with life
see multiple pregnancy
85
what are some facility based methods of measuring maternal deaths
```
health information systems
registries
confidential enquiries - MBRACE
maternal death review - in hospital
audits
```
86
is anterior or posterior placental praevia more difficult to identify?
posterior - more difficult to identify the posterior lower uterine segment
87
how is the mothers immune system transferred to the baby by breast feeding
antibodies
88
what are in labour risk factors for PPH
prolonged labour
induction or oxytocin use
operative birth
89
why is PKU screened for in neonates
untreated develop serious irreversible mental disability and epilepsy
treatment needed in 21 days
recessive condition
90
what is vase prevue
rupture of fetal vessels within fetal membranes over the cervix (blood loss is fetal)
91
why may a preterm labour be induced
```
placenta praevia
placental abruption
small baby
infection
pre eclampsia
```
92
what is the 1st ultrasound sign of pregnancy
thickening of the lining of the womb
93
what is a major complication of mono-chorionic multiple pregnancies
feto-fetal transfusion (FFT) - placental vascular anastomoses resulting in different sizes and one being born anaemic, the other jaundice (plethoric)
treat with laser coagulation
94
are mothers with a multiple pregnancy more or less likely to be affected by nausea and vomitting
more - higher HCG level
95
what signs may be seen on ultrasound that show multiple pregnancies
```
T sign (monochorionic)
lamda (dichorionic)
```
96
what test can be done on an IVF pregnancy to check for genetic diseases
Pre- implantation genetic diagnosis (PGD)
| costs £10,000
97
what are complications during multiple pregnancies
polyhydramnios
pre- eclampsia
anaemia commoner (increase Fe and folate requirements)
increased rate of antepartum haemorrhage and PPH
malpresentation more common
98
how often should you do vaginal examination in the 1st and 2nd stage of labour
1st - 4 hours
| 2nd - hourly
99
what are signs and symptoms of a PE in pregnancy
```
breathlessness
pain on breathing
cough
tachycardia
pleural rub
hypoxic
```
100
what is PKU (phenylketonuria)
inborn error of protein metabolism - inability to metabolise essential amino acid phenylalanine
high levels causes mental developmental impairment
101
how does cervical incompetence lead to an abortion
cervix opens prematurely with absent or minimal uterine activity and the pregnancy is expelled
trauma can be important
102
what sign on ultraousnd is typical of duodenal atresia
double bubble
103
what condition is cocaine/ crack strongly associated with in pregnancy
placental abruption
104
if a woman has anti D antibodies an has a rhesus positive foetus, what will happen
antibodies cross placenta and and lead to destruction of foetal RBC causing foetal anaemia / death
105
what is the difference between the maternal mortality ratio and maternal mortality rate
ratio - deaths during a time period / 100,000 live births of the same period
rate - deaths in time period/ 100,000 of reproductive age
106
list some neonatal morbidity as a result of prematurity
```
respiratory distress syndrome
intraventricular haemorrhage
cerebral palsy
nutrition
jaundice
increased infections
visual impairment/ hearing loss
```
107
what cancer should be exclude in a secondary PPH (by curette of the uterus)
choriocarcinoma
108
what does DIC stand for
disseminated intravascular coagulation
109
which test should diabetic mothers get repeatedly throughout their pregnancy
retinal assessment
110
how would you confirm foetal hypoxia
fetal blood sampling - pH < 7.24
| deliver immediately
111
what are risk factors for gestational diabetes
```
increased BMI >30
previous macrocosmic baby
previous GDM
family history
polyhydramnios (extra fluid)
```
112
what is the main direct and indirect cause of maternal death in the UK
direct - sepsis
| indirect - cardiac disease
113
what do studies predict is the main cause (50%) of spontaneous miscarriage
abnormal chromosomes -
114
what things does maternal diabetes increase the risk of
```
foetal congenital abnormalities
miscarriae
foetal macrosomia
shoulder dystocia / erbs palsy
stillbirth
pre-eclampsia
```
115
how may DIC in pregnancy present
heavy bleeding
| shock
116
when is a pregnancy test positive
9 days post conception (day 23 of a 28 day cycle)
until 20 weeks pregnancy
remain positive 5 says after miscarriage
117
what is an ectopic pregnancy
fertilised egg implants outside the uterine cavity
118
how would you investigate an ectopic pregnancy
US scan
serum BHCG levels
serum progesterone
119
what are antenatal risk factors for PPH
```
previous PPH/ retained placenta
BMI> 35
low maternal Hb <8.5g/l
antepartum haemorrhage
multiparity 4+, maternal age 35+
uterine malformations or fibroids
over distended uterus - polyhydramnos, twins
extravasated blood in the myometrium (abruption)
```
120
what is the difference between an early and a late neonatal death
early - 1st week
| late - first 28 days
121
if a woman has PKU what must she do when she is pregnant
low phenylalanine diet - prevent high levels reaching the developing fetal brain
122
what is a secondary post partum haemorrhage
excessive blood loss from the genital tract after 24h from delivery - 6 weeks
123
what is the process of amniocentesis
fluid taken form amniotic cell
124
what is the medical management of PPH
```
oxytocin
ergometrine
carboprast
misoprostil
tranexamic acid
```
125
what is placenta praevia
the placenta implants in the lower uterine segment to lie in front of the presenting part of the foetus
126
what is an intrapartum death
death of the baby in labour
127
what are society benefits of breast feeding
environmentally friendly
healthier population - lower NHS costs, reduced hospital admission
smarter humans - improved neocortex development
128
what are risks of MCMA twins
increased mortality - preterm labour, congenital abnormalities, growth restriction
placental insufficiency
feto-fetal transfusion syndrome
malpresentation
2nd twin 4x increased death due to hypoxia
129
what 5 things does the guthrie heel prick screen for
```
phenylketonuria (PKU)
congenital hypothyroidism (CHT)
sickle cell disorder (SCD)
Cystic fibrosis (CF)
MCASS - medium chain acyl-CoA deyhydrogenase deficiency
```
130
what test is done to screen for gestational diabetes
oral glucose tolerance test OGTT
131
why are palpitations felt in pregnancy
increase CO as increased SV and pulse rate
132
what should the foetal heart rate be
120-160 bpm
133
what is a 3rd degree perineal tear (a/b/c)
3a - external anal spinhcter < 50% torn
3b- external anal sphincter >50% torn
3c - both external & internal anal sphincters torn
134
what is a miscarriage (spontaneous abrotion)
the spontaneous termination of a pregnancy before 24 completed weeks gestation with no evidence of life
135
what is placental abruption
part of the placenta becomes detached from the wall of the uterus
136
what do pregnant women with type II diabetes on 26ypoglycaemic medications need to be switched to
insulin
137
what are the ages in weeks for mild, very and extremely pre term labour
mild - 32-36 weeks
very - 28-32 weeks
extremely - 24-28 weeks - poor prognosis
138
what is normal labour
occurs at 37 weeks gestation and results in the spontaneous vaginal delivery of baby within 24 hours
139
what are survival and disability rates in preterm gestation weeks (info)
```
<24 - 6% survive - 65% disabled
24 - 26% survive - 38% disabled
25 - 43% survive - 31% disabled
26- 48% survive - 26% disabled
27- 73% survive
28 - 84% survive
```
140
how common are ectopic pregnancies
1 in 90
141
what confirms the diagnosis of preterm labour
contraction and evidence of cervical change of VE
142
what things are involved in the ENAP every newborn action plan
ensure baby is breathing
start newborn on exclusive breast feeding
keep baby warm
wash hands before and after touching baby
143
what colour is a couvelaire uterus
blue with blood (concealed haemorrhage in placenta abruption)
144
how is the diagnosis of pre-eclampsia made
Mild HT on 2 occasions more than 4 hours apart or 1 measurement moderate- severe in
association with significant proteinuria (urine strip/ protein: creatine ratio/ 24hr urine collection)
145
what things does breast feeding reduce the risks of in the child
```
chest/ urinary/ ear infections
gastroenteritis
insulin dependent diabetes
childhood leukaemia
dental problems
```
146
how is gestational diabetes managed
control blood sugar - diet, metformin, insulin
| post delivery - check OGTT at 6-8 weeks
147
what is the management of a inevitable miscarriage
if heavy bleeding need evacuation
148
how are impending seizures treated in pre-eclampsia
magnesium sulphate bolus
| control BP - labetalol, nifedipine, methyldopa
149
what is the difference is the foetus between placental abruption and placental praevia
pa - normal lie/ presentation, absent/ distressed fetal heart
pp - abnormal lie/ presentation, fetal heart usually normal
150
what is pre-eclampsia (PET)
pregnancy induced hypertension with proteinuria +/- oedema
| develops after 20 weeks and usually resolves within 10 days of delivery
151
how is a stillbirth managed
labour ward test to establish cause
| induced labour
152
what is DIC in pregnancy secondary to
stimulation of coagulation by procoagulant substance release in the maternal circulation
153
how would you confirm true gestational diabetes
post delivery OGTT at 6-8 weeks - will be back to normal
154
when is an ectopic pregnancy surgically managed
if painful or about to ruptures
155
which is the more common type of post partum haemorrhage
99% primary
156
why is MCADD screened for in neonates
25% mortality rate
| babies can't break down fat to make energy - can lead to severe metabolic crisis if fasted/ off food
157
what are causes of PPH that do not fall in 4Ts
```
anaemia
induction of labour
BMI > 35
prolonged labour
age
```
158
what are procedure -related risks for a prolapsed cord
artificial rupture of membranes
vaginal manipulation of foetus with ruptured membranes
stabilising induction of labour
159
what are the main causes of maternal death worldwide
haemorrhage, sepsis, hypertensive disorders, obstructed labour, unsafe abortion
160
what tissues are incised in a episiotomy
vaginal epithelium
perineal skin
bulbocavernous muscle
superficial and deep transverse perineal muscle
161
what are tissue causes of PPH
retained products of conception
retained placenta
placenta accrete - placenta doesn't separate
162
when is there an increased risk of VTE in pregnancy
```
older mothers/ increased parity
increased BMI/ smokers
PET
dehydration
decreased mobility
operative deliver/ prolonged labour
family history
previous VTE
thrombophilia / sickle cell disease
```
163
what is meant by supine hypotension in pregnancy
gravid uterus compresses the IVC in supine women reducing the venous return
(place in left lateral position relieves pressure)
164
what screening tests are offer to pregnant woman
```
hepatitis B
syphillis
HIV
rubella
iron deficiency anaemia
iso immunisation
```
165
what fraction of woman experience a primary PPH
1/20
166
what is a 4th degree perineal tear
rectal mucosa involved
| tearing of perineal muscles, external & internal sphincters torn
167
why is pyelonephritis more common in the 3rd trimester
physiological hydronephrosis, easier path for ascending infection
(lower threshold for MSSU and antibiotics)
168
what do people need to know before undergoing a genetic test
```
what test is for
how it works
what happens if its positive
how likely it is to be positive
chances of false positive/ negative
```
169
what foetal abnormalities may occur as a complication of maternal diabetes
cardiac abnormalities
| sacral genesis - lower bit of spine missing
170
what is a prolapsed cord
descent of the umbilical cord through the cervix either alongside (occult) or in front (overt) of the presence of ruptured membranes
171
how long is breast feeding recommended for
6 months
| then up to 2 years
172
what should diabetics blood sugar and HbA1c ideally be pre-conception
4-7 mol/L
| HbA1c <6.5% - <48 mol/mol
173
how may a stillbirth be diagnosed
absent fetal movements US
| lack of fetal heart beat
174
what things are measured in first trimester screening to calculate risk of chromosomal abnormality
BhCG - beta human chorionic gonadotrophin
PAPP-A - pregnancy assoiciated plasma protein A
NT - nuchal translucency measurement
175
where is the blood from placenta praevia coming from
venous sinuses due to separation of the placenta as the lower uterine segment forms and the cervix stretches
176
what things may pre-pregnancy counselling be on
```
diet /exercise - food rich in folate acid
control chronic condition
immunisation
thromboprophylaxis
smoking cessation
alcohol
```
177
when is 1st trimester screening carried out
10-14 weeks gestation
178
where is the incision made for a caesarean
lower uterine segment - 3cm above pubic symphis
179
is the mean gestation shorter or longer for multiple pregnancies
shorter
| twins 37 weeks, triplets 33 weeks
180
what are tests for DIC in pregnancy
clotting time - increase
decrease fibrinogen
increase in fibrin degradation products
181
what is the management of a missed miscarriage (small and big)
if small - medical - prostaglandins (misoprostal) make uterus contract to expel pregnancy
if large - surgical management
182
what are pre-disposing factors for preterm labour
```
multiple pregnancy
polydramnios
APH
pre-eclampsia
infection
premature rupture of membranes
```
183
what is an incomplete miscarriage
only partial expulsion of the products of conception
risk of ascending infection into the uterus.
open cervix with heavy vaginal bleeding
184
what would be seen on the scan os a missed miscarriage
empty gestational sac or a fetal pole with no foetal heart
185
is there a routine 3rd trimester ultrasound
non
186
how is VTE treated in pregnancy
dalteparin for rest of pregnancy
187
how would you investigate a suspected PE in pregnancy
V/Q scan
| CT pulmonary angiogram
188
when in the 3rd stage of labour considered delayed
active - >30 mins
physiological > 60 mins
placenta unlikely to be expelled spontaneously past this
189
how may serum BHCG levels help decide between an ectopic or regular pregnancy
normal - intrauterine pregnancy HCG levels increase by at least 66% , ectopic don't
190
what is hyperemesis agravidarum
persistent vomiting in pregnancy
| affects 1% of women
191
what are tone causes of PPH
placenta praevia
over distension - multiple pregnancy, polyhydramnios, macrosomia
uterine relaxants
previous PPH
192
why is there increased micturition and frequency in pregnancy
pressure on pelvis from expanding uterus
193
how may an ectopic pregnancy present
period of amenorrhoea +/- vaginal bleeding
+/- pain in abdomen or shoulder (referred)
+/- GI or urinary symptoms - diarrhoea, nausea
194
what would you see on US scan of an ectopic pregnancy
no intrauterine gestational sac
| may see adnexal mass/ fluid in pouch of douglas
195
what its he CUB screening test for down syndrome
combined ultrasound and biochemical test - between 11 and 14 weeks
196
list some causes of obstetric shock
```
severe haemorrhage
ruptured/ inverted uterus
amniotic fluid embolus
septicaemia
pulmonar embolism
```
197
what genetic conditions are available for targeted testing in the UK
```
Cystic fibrosis - AR
tay-sachs - AR
haemoglobinopathy
sickle cell - AR
duchesses muscular dystrophy - AD
BRAC1/ 2
```
198
how is placenta praevia diagnosed
in ultrasound - low lying placenta
| MRI if inconclusive - identify cervical os
199
how may a HIV positive pregnant woman be managed
anti-virals do reduce CD4 load
deliver by C section
avoid breastfeeding
200
when is the second trimester ultrasound
20 weeks
201
what should a pregnant woman be advised to take to reduce the foetus chance of a neural tube defect
5mg folic acid
202
what are the effects of progesterone reducing CO2 on the mother
increased tidal volume, respiratory rate, plasma pH
| breathlessness
203
what is a 1st degree perineal tear
superficial tear, no muscle damage
204
what is the purpose of the 2nd trimester ultrasound
detect fetal abnormality - good for structural, bad for chromosomal
205
why may may maternal nephropathy and retinopathy occur in pregnancy
reduced awareness of hyperglycaemia
206
what is the definition of maternal mortality
the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of the pregnancy from any cause related to or aggravated by pregnancy/ management
207
how many deliveries previously predisposes a women to a PPH
4
208
what women are at risk of a rhesus antibody reaction and how is it prevented
rhesus negative women
| Anti D IgG - given prophylactically and after any sensitising events
209
what are known triggers for DIC in pregnancy
```
retention of dead foetus
pre eclampsia
placental abruption
endotoxic shock
amniotic fluid embolism
```
210
what is the surgical management of PPH
```
intrauterine balloon tamponade
interventional radiology
B-lynch suture (forces contraction)
hysterectomy
ligation of uterine/ iliac vessels
```
211
what are options for further testing of down syndrome
CVS
amniocentisis
non-invasive prenatal testing (compare mother, after and child DNA , not NHS)
212
when should you start treatment of gestational hypertension
>150/100
if 140/90 check BP and urine weekly
(>160/110 admit)
213
what position is used to deliver a baby with shoudler dystocia
McRoberts - hyper flexed lithotomy
214
what is classified as an antepartum haemorrhage
genital tract bleeding from 24 weeks gestation to delivery of baby
215
how would you manage a small ectopic pregnancy
methotrexate
216
what are signs and symptoms of a DVT in pregnancy
pain in calf
increased girth of affected leg
calf muscle tenderness
217
when can a mum deliver in placental praevia
>39 weeks
218
why is tay sachs enzyme disease available for target testing
fatal by 3-5 years
1 in 25 Ashkenazi Jews carriers, 1 in 250 normal
(lysosomal storage disease - build up of lipid in the brain), develops normal 6 months then progressive neurological deterioration)
219
what is the incidence of miscarriage
around 15% (normally 1st trimester)
220
what is the definition of the lifetime risk of maternal death
probability of maternal death during a woman's reproductive life, usually expressed in terms of odds
221
what is the management of a septic miscarriage
antibiotics and evacuate uterus
222
what are trauma causes of PPH
C section
episiotomy
macrosomia > 4kg
223
what pre-pregnancy conditions of the mum may need counselling
diabetes, high BP, epilepsy, hypothyroidism,
| genetic - spina bifida, thalassemia, CF
224
what are complications of episiotomy
bleeding
infection
haematoma formation
225
what is a threatened miscarriage
bleeding from the gravid uterus before 24 weeks gestation when there is a viable foetus and no evidence of cervial dilatation
226
what is the cure for pre-eclmapsia (PET)
delivery of baby
227
what is defined as a major post partum haemorrhage
>1L blood loss
| severe > 2000ml
228
what are thrombin causes of PPH
pre - eclampsia
placental abruption
pyrexia in labour
bleeding disorders - haemophilia, anticoagulation, vo willebrands disease
229
what is a late maternal death
occur >42 days - 1 year after termination, miscarriage or delivery that are due to direct or indirect maternal causes
230
what are the main causes of spontaneous miscarriage in
abnormal conceptus
uternine abnormality - congenital, fibroids
cervical incompetence
hormonal
maternal - increasing age, diabetes, thyroid
231
how is a cord prolapse managed
call for help
replace cord into vagina - minimal handling prevents spasm
digital elevation of presenting part
catheterise and fill bladder - elevates presenting part
arrange C section
232
is the corpus luteum is surgically removed in the first 8 weeks post conception, what will happen
miscarry within 7 days
233
what are complications of pre-eclampsia
eclampsia - seizures
severe hypertension - stroke (microaneurysm)
HELLP - haemolysis, elevated liver enzymes, low platelets
DIC - disseminated intravascular coagulation
renal failures
oedema
IUGR - intrauterine growth restriction
234
what are symptoms/ signs of a threatened miscarriage
vaginal bleeding
pain
closed cervix on speculum examination
235
what is placenta accrete
placenta doesn't separate
236
at what risk is further testing done for down syndrome
1 in 150
237
what is the difference between perinatal, infant and child deaths
perinatal - stillbirths/ deaths in 1st week
infant - first year of life
child - first 5 years of life
238
what is down syndrome
chromosomal abnormality characterised by 3 copies of chromosome 21
239
how may maternal mortality be prevented
antenatal care
skilled attendent at birth
emergency obstetric care available
240
what occurs in congenital rubble syndrome
mental handicap, blindness, deafness, heart defects
241
what are complication of placental abruption
```
maternal shock/ collapse - may be disproportionate
fetal death - lose blood supply
DIC
PPH
couvelaire uterus - blue with blood
uterine hypercontactility
```
242
what is the main method of neonatal screening
guthrie heel prick test at 5 days
243
what are the 4 classes of placental praevia
I - placenta enrolling on the lower segment but not internal os
II - placenta reaches the internal os of cervix
III- eccentrically covers the os of the cervix
IV- central
244
after how many caesarean sections is it customary to deliver by elective caesarean again
2
245
why may an elective C section in a diabetic mother be a good idea
prevent shoulder dystocia and Erb's palsy
246
what is follow up for gestational diabetes
post delivery OGTT at 6-8 weeks - will be back to normal
| yearly check on HbA1c/ blood sugars
247
list some different types of miscarriage
```
threatened
inevitable
incomplete
complete
septic
missed
```
248
what are signs of foetal distress
passage of meconium in labour
fetal tachycardia >160 bpm
loss of variability of baseline on CTG
249
what predisposes placental praevia to a post partum haemorrhage
poor lower segment contractility
250
which type of fibroids may cause spontaneous miscarriage
submucosal
251
why does constipation and heartburn occur in pregnancy
reduced got motility from progesterone, pyloric sphincter relaxes
252
when is a secondary post partum haemorrhage most likely to occur and due to what
5-12 days
| retained placental tissue or clot
253
what is detected on a pregnancy test
beta human chorionic gonadotrophin (BHCG)
254
what is the difference between direct and indirect maternal death
direct - related to obstetric complications during pregnancy, labour or puerperium or from any treatment received
indirect - resulting from previous existing disease or disease developed during pregnancy e.g. malaria, heart disease
255
how many pre-eclampsia present
may be asymptomatic - frequent screen
may mimic flu,
headache, blurred vision, epigastric/ below rib pain (liver congestion), sudden swelling of hands/ face/ legs
clonus/ brisk reflexes
papilloedema on fundoscopy
severe hypertension + >3+ urine proteinuria
256
what is the treatment of feto-fetal transfusion
laser coagulation of placental anastomosis
257
is pre term labour more common in single or multiple pregnancy
multiple (30-40%) - uterus is further stretched
| single 5-7%
258
how may is preterm labour managed
consider tocolysis to slow down contractions
steroids - help breathing
transfer to neonatal unit
259
what is the 3 delay model for the socio-cultural context of maternal death
delay in decision to seek care
delay in reach care
delay in receiving care
260
what things are checked in antenatal examination
BP , urinalysis
| abdominal palpation
261
what is sheehan's syndrome
pituitary necrosis leads to a lack of thyroid- stimulating hormone (TSH), adrenocorticotrophic hormone and gonadotrophin hormones
leads to hypothyroidism, addisonians and genital atrophy
262
what is a primary post partum haemorrhage
>500ml blood lost in first 24 hour
| sever >2000ml
263
why are symptoms of Hb SS rarely apparent until 3 months of age
effects of foetal haemoglobin
264
what is the immediate management of PPH
ABCDE - high flow oxygen, fluid replacement +/- blood products
empty bladder, rub up fundus
265
what is APH of unknown origin
haemorrhage form 24 weeks to before birth with no other cause
266
why is the risk of venous thromboembolism increased in pregnancy
hypercoaguble state - protects mother against bleeding of placenta post delivery
267
what things does breast feeding reduce the risks of in the mother
breast, uterine, ovarian cancer
type 2 DM
osteoporosis
improve mental health
268
what does foetal distress signify
hypoxia - can lead to foetal acidosis
269
on 2nd trimester ultrasound what is the normal shape of the cerebellum and the shape in neural tube defects
normal - dumbell
| NTd - lemon, frontal bossing
270
what is the difference between an occult and overt prolapsed cord
occult - alongside the ruptured membrane
| overt - in front of the ruptured membrane
271
what is the management of a threatened miscarriage
conservative
272
what are risk factors for ectopic pregnancies
pelvic inflammatory disease, endometriosis
previous tubal surgery
previous ectopic pregnancy
assisted conception - IVF
(anything that slows down passage to uterus)
273
what is the difference in embryology between dizygotic (fraternal) and monozygotic (identical twins)
dizygotic - two eggs, two seprm
| monozygotic - one egg, one sperm - sooner the egg splits the more independent the twins (late= conjoined)
274
what may be the result of fetal hyperinsulinaemia
macrosomia
275
why is it difficult to identify the reason for a spontaneous abortion
changes in fetal tissue after death interfere with chromosomal analysis
276
what is a missed miscarriage
a pregnancy in which the foetus has died but the uterus has made no attempt to expel the products on conception
277
how may an ectopic pregnancy rupture present
sudden severe pain, peritonism and shock
278
what does the placental abruption vary on
bleeding, general condition of mother and baby
| vaginal delivery - immediate caesarean
